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Form Ia 15 - Change Of Business Information Form For The Unemployment Insurance Program

Department of Labor - Unemployment Insurance Division

Registration Section

W A Harriman State Campus

IA 15

Albany, N.Y. 12240-0339

(11/97)

New York State Department of Labor

Employer Registration no.

Change of Business Information form

for the Unemployment Insurance Program

Employer Legal name

Return completed form to the address shown above

Street or PO Box

or fax to (518) 485-8010

City

State

ZIP Code

Need Help? Call (518) 457-5806

Signature required on reverse

Part A - Federal Employer Identification Number

1. Enter your Federal Employer Identification Number (FEIN) if your FEIN was not previously reported, is

is incorrect, or you have reported under an ID other than your FEIN. Also, enter your new FEIN if it has

changed as a result of a change in business entity, and complete Part B.

Part B - Discontinuance of Business/Change in Ownership/Name Changes

1. If your business or employment in NYS was permanently discontinued, indicate the date this occurred

(mmddyy)

2. Indicate if your business in New York State was sold or transferred:

All

Part

Enter date of transaction

(mmddyy)

Name of new owner:

Address of new owner:

3. If ownership*/business entity [i.e. partnership, sole proprietor, corporation, limited liability company

(LLC), limited liability partnership (LLP)] has changed, enter the date changed

(mmddyy)

Please explain:

*A corporate stock transfer or sale does not constitute a change in ownership for Unemployment Insurance purposes.

4. Name Changes:

If your business is a corporation, LLC, or LLP, you must make any legal name change with the Department of State

(DOS). Please contact DOS by telephone at (518) 473-2492, or write to: 41 State Street, Albany, N.Y. 12231. DOS

will process the name change and notify this agency accordingly.

Enter Date of Change

If your business is a partnership and there has been a change in partners, does your partnership agreement

allow for a change in partners without a dissolution of the partnership?

Yes

(mmddyy)

Name of new partnership:

If there has been a change in your trade name (doing business as), enter the new name:

5. If your business is a corporation and there has been a change in corporate officers, your business is a partnership and there has been a

change in partners (including LLP's and RLLP's), or your business is a LLC or PLLC and there has been a change in members, indicate

if an officer/partner/member is being added or removed (Del.), by completing the information below.

Social Security

Name

account no.

Title

Residence

Add

Del.

See reverse for address corrections

Form Ia 15 - Change Of Business Information Form For The Unemployment Insurance Program

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